51140 e No. Street Lot No.
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E JAN 9 151 APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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D Sanitary No.
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E Date iLrt y 19A 7.3 Permit No.-.S—/" 3
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3 Fee $ SG
r Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
° in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
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A v Use of Premises
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Owner1—�.P yt.c�i Address -5� ez
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By �• Gen. yl PNL� . Address /3 7c'-
3 Contractor,Age6f
°O� Phone_
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State License aP3.5.2,L k Approved—
Plumbing Inspector
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